27 August 1999
Programme Director, the Summit Steering Committee, Ladies and Gentlemen, it gives me great pleasure to address you at this important summit on nursing.
I also enjoyed the opportunity to meet many of you during the Banquet on Tuesday night where many of you looked absolutely stunning. If we had voted on that night on whether nurses should wear uniforms or not, I know exactly which way I would have cast my vote.
I have also been thrilled coming here and listening to some of the reports from the different commissions. I am convinced that you have engaged each other in very robust debates, but you have not been at each others throat.
I will not abuse this precious time you have given me to talk about my job, which is to transform the whole health service to improve access and quality of care to all South Africans. Rather I will concentrate only on 4 challenges facing the nursing profession, and these are: service delivery; training and preparation of nurses for service; support for nurses in the work environment; and professional development for nurses.
I am fully aware that this summit alone could not possibly resolve all the long-standing challenges, but I sincerely hope that, at least, you have put a process in place to address them.
By now everyone knows that the motto of this government is "A Better Life for All". in the health services, the nurses are at the forefront of the delivery of quality health care services to our people. The truth of the matter is that we rely upon you to provide the first level of care. You have been doing a good job of this and we encourage you to do so in the future. You know yourselves that it is not always necessary for clients to be seen by doctors and that nurses can attend to the majority of cases themselves, before referring the complicated cases to doctors. Therefore we value your contribution to the health service very much.
There are a few problems, however, in the manner in which services are rendered and we must confront these in an amicable spirit in this Summit. Research shows that many patients turn away from public health services not because the facilities are inadequate or there are no drugs, but because of the attitudes of those who provide care to them. Sometimes this includes doctors, registry clerks and nurses. But because this is a Nursing Summit, I will address myself to the issues affecting nurses.
Colleagues, I must say this categorically, it is totally unacceptable that client are shouted, abused and mistreated by nurses in the health services. This practice must stop at once. I rely on you to wage a campaign against these practices and to promote Batho Pele. I urge this Summit to come up with a way forward on how you will deal with attitudes amongst nurses and how you will promoted clients in the health services, especially the elderly, to be treated with respect and dignity. This government has also taken a deliberate decision to promote the Primary Health Care approach because we believe that it is the only comprehensive approach that will not only ensure that those requiring affordable health receive it, but it is the only way to develop and empower our communities.
I know that there is confusion on what Primary Health Care is about. Some think it is clinic care. Others think it is cheap medical care for Africans living in rural and remote areas. I believe that it is your duty to promote Primary Health Care amongst your colleagues and especially amongst the nursing students. It is a great pity that many health workers who have to work within this Primary Health Care Approach are in fact trained in an environment that promotes the exact opposite to Primary Health Care. This is one of the reasons why many of our nurses are doing well in England, the United States and the Arab Emirates. It is because we are training nurses for export markets rather than to care for our own communities. This situation must change and the power to change it is in your hands.
The third challenges which I would urge this Summit to address is the whole matter of the 'Scope of Practice'. We must define the scope of practice for nurse and amend the existing legislation to accommodate what we agree upon. This matter has been hovering around for decades and we can no longer delay it. I suggest that the Nursing Council should prioritise this work and we must come to some consensus as soon as possible, and then adjust the training and legislation accordingly in line with that vision. Nurses do not have to be doctors, but we must create the space for nurses to be nurses.
Once we have addressed the issues on service delivery, primary health care and scope of practice, it will be easy to address the training of nurses because we will know exactly what we would be training nurses to do. There are a few problems in this area too.
There is a groundswell of support for the review of the nursing curriculum and I do not understand why this work is not being addressed. I would urge this Summit to embark upon this programme as soon as possible in order to bring certainty and stability to the profession. Please remember that Primary Health Care and Batho Pele must be at the centre of the training of nurses.
You must address the controversial subject of the 'Primary Health Care Nurse'. My impression is that there are many programmes for the training of a Primary Health Care Nurse. This training is uncoordinated. There are different syllabi which do not speak to each other, the courses are of different lengths, some three months and other 12 months. There is also a cadre of nurses called the 'Community Nurse'. This is all very confusing. In the way forward I would encourage you to lay this subject to rest. You must agree on the definition of the 'PHC Nurse', what skills this cadre should have, how they are trained, where they are trained, how long they are trained, and what their competencies should be.
Coming to the issues of training. I am disappointed by the number of nurses trained since 1994. I would like you to put a programme in place for the massive training and re-orientation of nurses, especially those working in rural areas without immediate support from doctors. I am disappointed because we have received many pledges for training from International Collaborating Partners and yet we have not used all these opportunities and resources.
Another controversial matter around training is the transformation of training institutions. I am aware that amongst you there are many who are promoting that nurse education should take place in Technikons and Universities. There is also a substantial number who advocate for nurse training to take place in training institutions attached to public hospitals. I am not here to dictate to you how nurses must be trained but I would urge you to come up with a way forward on this matter and this must not be corrupted by self interest and the desire to build ivory towers for individuals at the expense of quality care to communities and sensitivity to the student nurse. In resolving this matter, I would urge you to be sensitive to the student nurses who come from poor homes and who join nursing in order to bring a little income home to support families who cannot support themselves. However, you must weigh the options and come up with concrete proposals.
With shrinking health budgets, you will have to confront, head-on, the whole subject of the rationalisation of training institutions. Are we training the right numbers of nurses for the health service and do we have sufficient training institutions. Are they too many or too few. Should we close some or open new ones. You must answer all these questions.
There have been several complaints that the public service cares for doctors and other health professionals more than nurse. I want to assure you that this is not true. If that is the impression that is created, it is very unfortunate.
I want to express my appreciation for the work done by nurses, especially those who have to man facilities on their own in the deep rural and remote areas, with no help in sight. I also want to pay tribute to the nurses who have to drive long distances in mobile clinics to provide health services to these remote areas. The nurses who work in urban areas also have similar challenges where they work in situations where their safety and security is often at risk. I want to pay tribute to all of you and to encourage you to hold on.
But I want to challenge you to come up with concrete proposals on what we can do to improve the working environment where you are, so that in turn, you may be able to serve our people with the same dedication and commitment that you have demonstrated so far.
I also would like to challenge you to look beyond monetary incentives and think about those improvements which would make a big impact to your quality of life and service.
I challenge you to make proposals to us on, for example, telecommunications, telemedicine, clinical decision support, referral systems, electricity, water, sanitation, etc.
This is your health service too. Help us plan it with you.
I am very interested in the personal and professional development of our workforce, because I believe that it is only when you are empowered, that you will develop the nation.
At this Summit, I would also want to encourage you to interrogate the role of the Nursing Council and to make sure that it serves your professional interests and make suggestions to us on what we can do to improve the relationship between ourselves, yourselves and your council. I can assure you that we have no interest in interfering in the manner in which you conduct your business. Ours is to encourage your professional independence and to encourage your council to maintain high professional standards and excellence and a good name in society.
I know that many of you also belong to unions and staff associations. I sincerely believe that sometimes these organisations can play a very positive role in your development and in improving yourself. I would therefore encourage you to become form constructive partnerships with government as an employer as I am sure that we would do everything to make sure that you, as a workforce, are happy and at the end of the day, we can delivery quality and uninterrupted services to our people.
In conclusion, Programme Director, I would like to invite you to compose a small Task Team that will concertise the proposals coming out of this Summit and to hold discussions with my Department, very soon, to discuss whatever proposals you have to improve service delivery and the status of nurses